use of ict to monitor and improve women’s and children’s health in bangladesh (english)
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Adbul Kalam Azad.“Use of ICT to Monitor and Improve Women’s and Children’s Health in Bangladesh." (English)Presentations to the Second Stakeholders Meeting on Implementing the Recommendations of the Commission on Information and Accountability for Women's and Children's Health Ottawa. Session 1 - General Perspectives Plenary Panel 21-22 November 2011TRANSCRIPT
Prof. Dr A. K. Azad
Additional Director General &
Director, Management Information System
Directorate General of Health Services
Ministry of Health & Family Welfare
21 November 2011
IndiaIndia
Myanmar
Bay of Bengal
Indian Ocean
A small country A small country A small country A small country in Southin Southin Southin South----East AsiaEast AsiaEast AsiaEast Asia•Land Area:
147,570 sq. km.•Population:
~150 million•Population density:
964/sq. km.
AchievementAchievementAchievementAchievement
•MDG4MDG4MDG4MDG4 – Well on track; UN MDG4 Award 2010
•MDG5MDG5MDG5MDG5 – On track; 2/3rds MMR Reduction from 1990
•eHealtheHealtheHealtheHealth - UN Digital Health for Digital Development Award 2011 for contributing to MDGs
� We believed - ICT could help improve HIS for measurement of health sector progress
� But, we had resource constraints
� So, we undertook a model of ICT deployment, that is:
◦ Simple
◦ Low cost
◦ Innovative &
◦ Locally appropriate
� This presentation captures some of the glimpses
Super-specialized Hospitals
Tertiary Hospital /Medical College Hospital
District Hospital /Medical College Hospital
Sub-district Hospital
Union Health Center (Day care)
Community Clinic (Day care)Community Health Workers
About 600 hospitals
About 19,000 day-care facilities
About 100,000 health workforce
Internet Internet Internet Internet connectedconnectedconnectedconnectedApril 2009April 2009April 2009April 2009
To be To be To be To be connected connected connected connected from this from this from this from this fiscalfiscalfiscalfiscal
Device: Wireless Internet – Edge Modem
DHIS 2.0 DHIS 2.0 DHIS 2.0 DHIS 2.0 ---- Open Source SWOpen Source SWOpen Source SWOpen Source SWWe are using
Data entered at sourceData entered at sourceData entered at sourceData entered at source
• Same platform for public & private;• End users need no software ; Inherent interoperability; • Data gathered quickly; Better quality; No need for compilation at any level
We can checkwho sent data, who not
Dash boardDash boardDash boardDash board
We can produce automatic reportWe can produce automatic reportWe can produce automatic reportWe can produce automatic report
We can produce GIS mapWe can produce GIS mapWe can produce GIS mapWe can produce GIS map
� By DHIS 2.0, currently we collect only aggregate data
� But, we are moving to case by case data collection
Household InformationHousehold InformationHousehold InformationHousehold Information
•House code: Division-District-Upazila-Union-Ward-Household
•Drinking water source
•Latrine
•Economic situation
•Important mobile phone numbers (3)
Household Member(s) InformationHousehold Member(s) InformationHousehold Member(s) InformationHousehold Member(s) Information
•Serial No. & Name
•National ID
•Date of birth
•Sex
•Marital status
•Education
•Occupation
•Religion
•Chronic disease
•Date of death
•Cause of death
Basic data setBasic data setBasic data setBasic data set
Unique ID
Ambitious Program
Verbal Verbal Verbal Verbal AutopsyAutopsyAutopsyAutopsy
85% data collection completed
Population data: new birth (live or still), birth weight, maternal death, other death, pregnancy, ANC, NCD, Economic condition, water source, latrine
Community health service: domiciliary visits, medication, immunization, Vit A cap, albendazole, ANC, PNC, Newborn care
Sub-district
District
Health worker
Community Clinic
Health service Health service Health service Health service informationinformationinformationinformation
Population Population Population Population datadatadatadata
FY2011-2016
Union Health Facility
National
CloudCloudCloudCloud
CIDA is a CIDA is a CIDA is a CIDA is a partnerpartnerpartnerpartner
Supported by WHO & Health Metrics Network
A partnership of public-private-NGO-local organizations
Field implementation: March 2011
Data maintained by MOH
MOVE-IT Electronic Health Record
Web-Based Electronic System
Bangladesh Bureau of Statistics
Data entry by health worker at the community
Data entry by health personnel at the facilities
MOVEMOVEMOVEMOVE----IT: IT: IT: IT: to capture data at point of contact or careto capture data at point of contact or careto capture data at point of contact or careto capture data at point of contact or care
� Our routine HIS is already providing lot of current
data
� We adopted HMN Framework for HIS
� We hope that our efforts will:
◦ minimize needs for health surveys
◦ provide information on all core elements almost real time
to support evidence based planning & decision
making
1. An attempt of Prime Minister’s Office
2. Aims to harmonize & inter-operate data use & services
3. One common Govt. authority will provide
o Unique ID
o Citizen’s Core Data Structure (13 fields textual)
o Biometrics (photo, finger prints (10), iris, face)
4. Service ministries will feed & use service data
Bangladesh National e-Governance Architecture
Open e-Services Bus
BB
S
M0
H
National Statistics
Director, Health MISPregnant
Mothers,
Newborn
Deaths
MoX
Other Countries
NGOs
Global Health IS
Standards by
Government
National Population
Register
MO
VE
-IT
Other
Health
Systems
Conceptual framework of National eConceptual framework of National eConceptual framework of National eConceptual framework of National e----Health ArchitectureHealth ArchitectureHealth ArchitectureHealth Architecture
� Mobile phone given to every district & sub-district hospital
� Total 482 hospitals
� Women & people can call 24h/7days & get freemedical advice from on-duty doctor
Easier for women to seek health care for herself & children from home
Watch video at www.dghs.gov.bd>Video gallery
Mobile Phone Health Service ExampleExampleExampleExample----1111
More doctors in work place: better health for women & children
Watch video at www.dghs.gov.bd>Video gallery
The system uses:The system uses:The system uses:The system uses:
ExampleExampleExampleExample----2222
Tele-medicineExampleExampleExampleExample----3333
Telemedicine for rural people, women & Telemedicine for rural people, women & Telemedicine for rural people, women & Telemedicine for rural people, women & children (in 18,000 Community Clinics)children (in 18,000 Community Clinics)children (in 18,000 Community Clinics)children (in 18,000 Community Clinics)
FirstFirstFirstFirst TrimesterTrimesterTrimesterTrimester
InstantInstantInstantInstant
≥≥≥≥60 to 60 to 60 to 60 to ≤≤≤≤90 90 90 90 daysdaysdaysdays
Pregnancy Care Advice by SMS
Send Send Send Send <<<<LMP: ddmmyyyy> <Mobile No.> <Name>>>>
Second TrimesterSecond TrimesterSecond TrimesterSecond Trimester
180 180 180 180 daysdaysdaysdays
Third TrimesterThird TrimesterThird TrimesterThird Trimester
240 240 240 240 daysdaysdaysdays
255 days255 days255 days255 days
ExampleExampleExampleExample----4444
PPPPPPPPPPPPVoiceVoiceVoiceVoiceIVRIVRIVRIVR
Mobile phone in BangladeshMobile phone in BangladeshMobile phone in BangladeshMobile phone in Bangladesh
� Empowered women
� Scaled up Internet connectivity
We leveraged this opportunity for improving health of citizens.